The other night I did a live Twitter ‘thing’ as part of my reaction to BBC’s In The Mind season. I hoped to spread awareness of my own mental illness, Borderline Personality Disorder or BPD for short.
This was the culmination of the bitterness and anger I have felt over the last couple of months, in which I have been told twice, whilst in ‘crisis’, by two separate mental health professionals that Personality Disorders are not ‘serious mental illnesses’.
So, I took to Facebook and Twitter to vent about how serious ALL mental illnesses are and to try to help put an end to what I have called The Hierarchy of Mental Illness. So much stigma still surrounds Personality Disorders, it’s the huge elephant in the room of mental health. A lot of people simply do not understand.
So, BPD, what’s all that about? Basically it’s a set of nine symptoms, which occur in individuals to varying levels of severity, and in various combinations. To be diagnosed, you must suffer from five of the nine symptoms.
Let’s tackle the diagnostic criteria head on. (Remember, people are INDIVIDUALS and not EXAMPLES!)
1. You feel very worried about people abandoning you, yet you push people away. You find it very hard to trust people.
2. You have intense, unpredictable moods and emotions. Your mood can go from depression to hypomania and back again, usually very rapidly and without warning. Your self-esteem fluctuates accordingly. You can go from feeling invincible and amazing one minutes and completely worthless the next.
3. You don’t have a strong sense of who you are. You are a ‘social chameleon’. You adapt to fit into the situation you’re in. You may find that your goals and ambitions change frequently. Sometimes this results in severe depersonalisation. That’s when you feel like you don’t exist, or you’re in a movie, or you’re ‘spaced out’.
4. You find it very hard to make and keep stable relationships. Often because of past abuse. This can result in idolising someone one day and hating them the next. You may find your relationships with people are very intense and often end quickly.
5. You’re reckless and impulsive and do things that could potentially harm you. Such as excessive spending, binge eating or substance abuse. You take big risks and can get into dangerous situations.
6. You have frequent and severe suicidal ideation and/or you self harm. Often your self harm becomes worse over time because you need to inflict more damage to yourself in order to get the same sense of relief. One in ten people with BPD will successively commit suicide, many more attempt suicide.
7. You feel hollow and empty. Nothing fills you up. You feel intensely lonely.
8. You get very angry. Or, you don’t process your anger properly and ‘blow up’ over small things.
9. You suffer from paranoia, dissociation and psychotic episodes, including hallucinations such as hearing voices.
So, what causes BPD. There are a number of theories, both environmental and genetic, although very often BPD is linked to childhood trauma, such as neglect, emotional, physical and sexual abuse or losing someone close. The most important thing I can stress is that having a diagnosis of BPD DOES NOT mean that your personality is ‘bad’ or that you are a ‘bad person’. It’s an ILLNESS. An illness that completely destroys you life, your happiness and your ability to function normally. Some people think having BPD makes you manipulative. This is simply not true. You experience real and severe emotional pain, which effects how you behave. You’re desperate and hurting and you don’t have the skills to express this appropriately. Some people say Borderlines are abusive, although to that the above also applies and, contrarily, individuals with BPD are 99% of the time abuse SURVIVORS. It’s really inappropriate to call the abusive when they’re simply hurting and unable to deal or process it effectively.
So, can it be treated? Definitely. It can seem like a life sentence, and to some extent that’s true, but there are definitely treatments out there that can help manage the severity of your symptoms. I can only tell you what has helped me.
The first thing that has helped me is PILLS! Pills are great. I would recommend pills. First of all, antidepressants. Currently, I take 45mg of Mirtazapine and 50mg of Paroxetine. They help ease my depression, my anxiety and my co-morbid OCD. It took me a long time to find the right ADs. I tried pretty much EVERY AD at pretty much EVERY dosage before my brain settled down on this combination. Mood stabilisers are also very helpful. They help control the intense mood swings and impulsivity, currently I take 200mg of Lamictal and it works really well. Finally, anti psychotics can be helpful. I struggle with the psychotic symptoms of BPD much more than the other symptoms, so AP’s have been crucial to keeping me out of hospital. I tried a lot before settling on a depot injection of 75mg of Haldol once a fortnight. I’ve been on this for nearly a year and it has transformed my life. This combination works really well for me (although I still have struggles) and so yes, anyone who says meds don’t help with BPD is an idiot.
Secondly, therapy. THIS IS SO IMPORTANT. Because BPD is so often caused by painful events in the past & they need processing, and even if there is no trauma, you will need to work to change your thought patterns and regulate your emotions. The ‘go to’ therapy for BPD is called DBT. This is given in both a group and individual setting and works primarily in controlling emotions, mindfulness skills, interpersonal skills and distress tolerance. Personally, I never found it overly helpful but it works really well for a lot of people. For me, ‘talking’ (otherwise known as Psychodynamic) therapy is where the real benefit has been found. This involves ‘opening up’ about your experiences and finding ways of processing them in a way that allows you to grow. However, with any therapy, you have to make a big commitment and often you’re going to feel worse before you feel better. For me, the combination of the right medication and the right therapist have been life saving.
BPD ruined my life, for someone to say it’s not ‘serious’ is idiotic and invalidating. I have taken countless overdoses, self harmed thousands of times, often to the point of needing medical attention, I have hallucinated terrifying visions and voices and had episodes of depression so severe I’ve been unable to get out of bed and I’ve been admitted to psychiatric hospital many times. For someone to invalidate my experiences is downright WRONG. I have fucking SUFFERED, through the childhood abuse and rapes that lead to my illness, to the diagnosis and subsequent mistreatment of the mental health profession.
In writing this, I am hoping that people will be more aware of BapD, and that the stigma that still surrounds it can be shifted.